Sunday, December 12, 2010

A nurse called me yesterday because a patient was getting worse, fast. So I ordered a STAT CT scan of her head.

So Ms. Nurse asked if I wanted just a head CT, or a if I'd prefer to do a "Stroke Alert!".

This was a new one to me. She explained that a "Stroke Alert!" is a new protocol developed by my hyperactive colleague, Dr. Nerve. When a "Stroke Alert!" is ordered they automatically do a head CT, EKG, a few labs, and call a Nurse Practitioner who's in the hospital to come assess the patient.

So I said what the hell. Let's do a "Stroke Alert!". She said she'd take care of it, and got off the phone.

Our hospital instituted this stupidity as well. We had a lady 3 days into a small stroke who was complaining of a headache and the neurologist and I, who had just left the room, decided to get another CT. After I place the order, I get a call, "would you like to institute the stroke alert?" The advantage, you see, would be to have an NP examine the patient instead of just 2 board certified physicians. Oh, and we get an EEG, even though we already had a negative one on the chart. And we get to have calls made to the 2 doctors on the case informing us of the stroke alert. Oh, brother.

our hospital has a number of automatic page clusters. trauma code, cardiac arrest, regional disaster, stolen baby, bed crunch, etc. i think it is meant to be sure nothing is overlooked in a crisis, and it shows that the hospital has a policy in place. this pleases jhaco. maybe your hospital wants to be a stroke center of excellence. now you know what happens when you push that shiny red button.

It sounds like someone other than the neurologist on call is the one that usually calls for the "stroke alert" if the neuro gets paged when it happens. Maybe someone like intern, hospitalist, resident, etc sets it up.

While I agree that redundancy is a pain, it can save your hind end in some situations. Better looked at twice than over looked at all.

We have sheets with protocols for common presentations in the veterinary ER: toxicities, GDV, pancreatitis, hit by car/trauma that include several items "marked" or suggested that the Dr on shift just circles which ones apply in that case.

On the one hand, this is a case of someone not using their own judgment and blindly following protocols. On the other hand, do you *really* want this person to use their own judgment??? I'll take blindly following protocols ANY day. . .

We have a stroke alert protocol in our ED but it doesn't include an exclamation point like yours does, and now I feel like ours is lacking. I'm a little jealous, frankly. Ours gets you a CT scan with and without contrast, as well as a bunch of extra paperwork and charting and someone gets the tPA out and sets it on the charge nurse's desk. And everyone feels extra alert. Or, in your case, alert!

Shortly after flights resumed post 9/11, I was preparing to leave on an early flight out of North Plate, NE. I was the only person on the flight except for the pilot and co-pilot. I checked in at the counter, showed my ID and ticket, and received my boarding pass. Fifteen minutes later they started boarding. The same person that checked me 15 minutes previously now asked to see my ID and boarding pass. Again, I was the only passenger on the plane. Protocol. Aghhh.

I agree with the last anonymous... if he hadn't informed you, he might've gotten in trouble if anything went wrong. Though, he didn't have to play brainless like that; he could have informed you he was documenting that he'd informed the neuro on call of the stroke alert, instead.

We have the stroke alert thingy too although I believe we don't have the NP. In addition to the CT and other tests a stroke alert is an overhead page and generates the arrival of the stroke alert TEAM which includes lab, docs, various other disciplines including the chaplain. The advantage is certainly not the chaplain but the fact that the stroke alert patient gets priority for the CT scanner.

So call the hospital backat some annoying period of time (maybe 15-45 minutes, depends on how grumpy you are and how long it takes you to get back to sleep) later and page the doofus who called you about the stroke alert to thank him for letting you know.

Next, get the stupid protocol changed at your earliest convenience to include "Do not call the neurologist who ordered the stroke alert!"

In my hospital I think the stroke alert bumps someone up to the top of the CT list (or at least near the top, say, ahead of the stone study in the VSS twentysomething, but behind the MVC with abdominal tenderness).

Welcome to my whining!

This blog is entirely for entertainment purposes. All posts about patients may be fictional, or be my experience, or were submitted by a reader, or any combination of the above. Factual statements may or may not be accurate.

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